金昌市5所医院2005年临床分离菌耐药性分析

Surveillance of drug resistance of clinical islated bacteria from 5 Jinchang hospitals in 2005

目的调查金昌市5所二级以上医院临床标本分离菌的菌种分布及其对常用抗菌药物的耐药状况。方法收集上述医院2005年临床标本分离的细菌,采用K-B琼脂扩散法进行药敏试验,按美国临床实验室标准化委员会2005版标准判定结果;采用WHONET5.0软件对数据进行统计分析。结果共分离546株菌,其中革兰阴性(G-)菌365株(66.85%),革兰阳性(G+)球菌181株(33.15%)。G-杆菌分离率最高的为大肠埃希菌16.67%,其中大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌分别占18.68%和15.38%;分离率最高的G+球菌为金黄色葡萄球菌(15.20%)和凝固酶阴性葡萄球菌(9.89%),未分离出耐万古霉素金黄色葡萄球菌。大肠埃希菌对氟喹诺酮类药物和庆大霉素的耐药率接近或>50%;阴沟肠杆菌和弗劳地枸橼酸杆菌对第一代头孢菌素的耐药率接近或达到80%;铜绿假单胞菌对亚胺培南的耐药率达19.73%;鲍曼不动杆菌对亚胺培南的耐药率达11.87%。结论临床标本分离菌耐药现象十分普遍,多重耐药性日趋严重。加强细菌学检验,及时了解其耐药性变迁对指导临床合理用药,有效控制感染具有重要意义。

Objective To investigate distribution of bacteria isolated from clinic and resistance to commonly used antimicrobial agents in 5 two-grade Jinchang hospitals. Methods Clinical bacterial strains isolated from above hospitals in 2005 were collected, bacterial susceptibility tests were performed using Kirby-Bauer method and the results were analyzed according to NCCLS （2005） by WHONET5.0 software. Results Five hundred and forty-six strains were isolated, 365 strains （66. 85 %） were gram-negative bacilli, 181 （33.15 %） were gram-positive cocci. The main gram-negative bacilli were Escherichia coli（ 16. 67 % ）, the rate of ESBLs-producing strains of Escherichia coli and Klebsiella pneumonia was 18. 68% and 15. 38% respectively; The main gram-positive cocci was Staphylococcus aureus （ 15. 20% ） and Coagulase negative staphylococcus （ 9.89% ）, vancomycin-resistant Staphylococcus were not isolated. The resistant rate of Escherichia coli to fluoroqulnolones and gentamycin was about or 〉 50% ;The resistant rate of Enterobacter cloacae and Citrobacter freundii to the first generation eephalosporins was up to 80%, The resistant rate of Pseudomonas aeruginosa to imipenem was 19.73%; the resistant rate ofAcinetobacter baumannii to imipenem was 11.87%. Conclusion Antimierobial resistanee in clinieal baeteria is serious, in order to guide rational use of antimicrobial agents and control nosocomial infeetion, baeteria deteetion should be stressed.